Somita Keita

Epidemiologic aspects of scabies in Mali, Malawi, and Cambodia

Background The prevalence rates of scabies are compared in Bamako, Mali, Karonga District, Malawi, and Battambang Province, Cambodia.

Integration of basic dermatological care into primary health care services in Mali.

OBJECTIVE To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases--a neglected component of primary health care in such regions. METHODS We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries.

Discrepant prevalence and incidence of Leishmania infection between two neighboring villages in Central Mali based on Leishmanin skin test surveys.

Apart from a single report, the last publication of cutaneous leishmaniasis (CL) in Mali dates back more than 20 years. The absence of information on the current status of CL in Mali led us to conduct a cohort study in Kemena and Sougoula, two villages in Central Mali from which cases of CL have been recently diagnosed by Malis reference dermatology center in Bamako. In May 2006, we determined the baseline prevalence of Leishmania infection in the two villages using the leishmanin skin test (LST). LST-negative individuals were then re-tested over two consecutive years to estimate the annual incidence of Leishmania infection. The prevalence of Leishmania infection was significantly higher in Kemena than in Sougoula (45.4% vs. 19.9%; OR: 3.36, CI: 2.66–4.18). The annual incidence of Leishmania infection was also significantly higher in Kemena (18.5% and 17% for 2007 and 2008, respectively) than in Sougoula (5.7% for both years). These data demonstrate that the risk of Leishmania infection was stable in both villages and confirm the initial observation of a significantly higher risk of infection in Kemena (OR: 3.78; CI: 2.45–6.18 in 2007; and OR: 3.36; CI: 1.95–5.8 in 2008; P<0.005). The absence of spatial clustering of LST-positive individuals in both villages indicated that transmission may be occurring anywhere within the villages. Although Kemena and Sougoula are only 5 km apart and share epidemiologic characteristics such as stable transmission and random distribution of LST-positive individuals, they differ markedly in the prevalence and annual incidence of Leishmania infection. Here we establish ongoing transmission of Leishmania in Kemena and Sougoula, Central Mali, and are currently investigating the underlying factors that may be responsible for the discrepant infection rates we observed between them. Trial Registration ClinicalTrials.gov NCT00344084

Side effects of depigmenting products in Bamako, Mali

There can be no doubt that, generally speaking, having beautiful, radiant skin is by no means a matter of minor concern for women in Mali, as for those in other countries. They therefore use all available means to enhance their skin: foundation, other types of make-up and, increasingly, skin-bleaching products. The use of skin-bleaching products has become a fashionable practice in recent years in our African villages, involving mainly women but sometimes both sexes. Termed “caco” in Mali and “xeesal” in Senegal, the users of these products have been increasing in number: prevalences of 25% in Bamako 1 and 59% in Togo 2 have been reported. The financial impact of the practice is by no means negligible, and cutaneous complications are very frequent. 3 However, the risk of any specific complication occurring is not the same for all the complications which are likely to occur. Risks vary from one individual to another and are also connected with the type of product used. The aim of this study was to quantify the risk of cutaneous complications occurring in connection with the cosmetic use of skin-bleaching products.

Hair Care and Hair Styles in Women in Bamako, Mali

In contrast to Caucasian hair, which is fine and silky, black African hair has a dry and frizzy consistency. In both sexes, the natural hairstyle formed by the hair is used in various contexts as a means of self-expression, in particular to express female beauty. 1 Dry and frizzy hair does not easily lend itself to different methods of hair styling. Nevertheless, our hair salons produce hair styles that are impressive in aesthetic terms but which are poorly documented. 2 Hair care may also be sought for scalp problems such as pruritus, dandruff and alopecia. The types of hair care and styles available, as well as the side effects of the techniques employed, are poorly understood in Bamako. The aim of this study was to acquire a better understanding of the hair care and hair styling carried out in salons and hairdressing centers, as well as the side effects of these procedures observed in women in Bamako.

Prevalence of Cutaneous Leishmaniasis in Districts of High and Low Endemicity in Mali.

Historically the western sahelian dry regions of Mali are known to be highly endemic for cutaneous leishmaniasis (CL) caused by Leishmania major, while cases are rarely reported from the Southern savanna forest of the country. Here, we report baseline prevalence of CL infection in 3 ecologically distinct districts of Mali (dry sahelian, north savanna and southern savanna forest areas). We screened 195 to 250 subjects from 50 to 60 randomly selected households in each of the 6 villages (four from the western sahelian district of Diema in Kayes region, one from the central district of Kolokani and one from the southern savanna district of Kolodieba, region of Sikasso). The screening consisted of: 1] A Leishmanin Skin Test (LST) for detection of exposure to Leishmania parasites; 2] clinical examination of suspected lesions, followed by validation with PCR and 3] finger prick blood sample to determine antibody levels to sand fly saliva. LST positivity was higher in the western district of Diema (49.9%) than in Kolokani (24.9%) and was much lower in Kolondieba (2.6%). LST positivity increased with age rising from 13.8% to 88% in Diema for age groups 2–5 years and 41–65 years, respectively. All eight PCR-confirmed L. major CL cases were diagnosed in subjects below 18 years of age and all were residents of the district of Diema. Exposure to sand fly bites, measured by anti-saliva antibody titers, was comparable in individuals living in all three districts. However, antibody titers were significantly higher in LST positive individuals (P<0.0001). In conclusion, CL transmission remains active in the western region of Mali where lesions were mainly prevalent among children under 18 years old. LST positivity correlated to higher levels of antibodies to sand fly salivary proteins, suggesting their potential as a risk marker for CL acquisition in Mali.

Cutaneous Leishmaniasis in Mali

While not as common as in other parts of the world, cutaneous leishmaniasis is endemic to countries in Africa, particularly in the north, central, east, and south. Sporadic case reports of cutaneous leishmaniasis in countries spanning West Africa have allowed scientists to propose an endemic belt in sub-Saharan Africa ranging from Senegal to Cameroon. While the presence of cutaneous leishmaniasis in West Africa is well established, there is a paucity of data regarding the parasite species, vector, and reservoir responsible for the disease in this part of the continent. This article focuses on cutaneous leishmaniasis in Mali, West Africa.

A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

Pruritus in dermatological hospital in Bamako, Mali

Pruritus is a symptom frequently encountered in dermatology consultations. For practitioners working in a tropical environment, particularly in Africa, the diagnosis of pruritus remains a constant problem. The aim of this study was to describe the epidemioclinical aspects and the etiologies of pruritus encountered at the dermatological hospital in Bamako. We conducted a prospective survey on a cohort of patients attending the Department of Dermatology at the Centre National d’Appui (CNAM‐Ex Institut Marchoux) in the Fight against Disease over a 1‐year period (June 1, 2009–May 31, 2010). Consequently, the study included every patient, whatever their age and gender, that agreed to take part in the survey and whose main reason for attending for a consultation was “pruritus.” The clinical and biological data were entered and analyzed using Epi Info software, version 6.04 fr. A total of 232 patients (163 women, 69 men) attended because of pruritus out of 1761 overall patients (i.e., a prevalence of 13.17%). The mean age of the patients was 33 ± 19 years. Dermatological causes represented 95% of the etiologies. This work allowed us to observe the systemic causes of pruritus in the dermatological environment in Mali and greater likelihood of black women to attend because of pruritus.

Dermatitis of the folds in black Africans in Bamako, Mali

Dermatitis of the folds (intertrigo) is a frequent reason for attending consultations, particularly in Africa, where the hot and humid climate constitute an aggravating factor. It is a complex pathology with multiple and intricate etiologies. The aim of this study was to describe epidemiological and etiological aspects of dermatitis of the folds in black‐skinned subjects in Bamako (Mali). We conducted a transversal descriptive survey of cases of localized dermatitis of the folds of the skin in dermatology clinics in Bamako. In total, 141 cases of intertrigo were identified: 96 female subjects (68%) and 45 male subjects. The average age of patients was 30 ± 18 years (2–80 years). The majority of patients were seen between March and June; 52% of patients had already received treatment before the consultation. The lesions affected skin folds of the groin area and/or area between the buttocks in 95 patients (57.4%), and folds of the armpits and area under the breasts were affected in 46 cases (42.6%). Eczema, erythrasma, and fungal disease were the most frequently observed pathologies. Of interest to this study is the topographical approach that a dermatologist must adopt when diagnosing certain forms of dermatitis. In populations with specific cultural practices, apart from a thorough knowledge of these specific factors, treatment of these conditions requires certain harmful attitudes and behaviors to be abandoned.